Names and pronunciation
(sar-il′ue-mab) Kevzara
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Drug reference
(sar-il′ue-mab) Kevzara
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Func. class.: Antirheumatic, immuno- suppressive
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Chem. class.: Interleukin antagonist, monoclonal antibody
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ACTION: Inhibits interleukin-6 (IL-6) receptors by binding to both forms of IL-6 receptors, antiinflammatory action and a reduction in C-reactive protein
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USES: Treatment of adults with mod- erately to severely active rheumatoid arthritis in patients who have had an inadequate response or intolerance to one or more disease-modifying antirheu- matic drugs (DMARDs); used as mono- therapy or in combination with metho- trexate or DMARDs
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CONTRAINDICATIONS: Hyper- sensitivity, active infections, active severe hepatic disease, ANC <2000/mm3, plate- lets <150,000/mm3, TB Precautions: Chronic/recurrent infec- tions, corticosteroid therapy, diabetes mellitus, diverticulitis, risk of GI perfora- tion, hepatic disease (Child-Pugh B), se- vere renal disease, pregnancy, lactation, children, geriatric patients, HIV, neoplas- tic disease
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Black Box Warning: Infection
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SIDE EFFECTS GI: GI perforation, abscess, gastroenteritis GU: UTI HEMA: Thrombocytopenia, neutropenia, leukopenia, anemia INTEG: Injection site reactions, rash, pruritus MISC: Infections (TB), hypersensitivity, immunosuppression, malignancy RESP: URI, dyspnea, nasopharyngitis
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INTERACTIONS • Increase: immunosuppression, infec- tions—DMARDs, TNF antagonists, corti- costeroids, live virus vaccines • Altered effect: CYP450 substrates (cyclosporine, atorvastatin, lovastatin, theophylline, warfarin, hormonal con- traceptives); monitor substrate levels
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DOSAGE AND ROUTES • Adult: SUBCUT 200 mg q2wk Dosage modifications Lab Value Recommendation ANC 0.5-1 × Hold until ANC 1 109/L × 109/L ANC <0.5 × Discontinue 109/L Platelets Hold until >100 × 50-100 × 103/ 103/mcl mcl S Platelets < 50 Discontinue × 103/mcl ALT >1 to ≤3 Consider dose × ULN modification ALT >3 to ≤5 Hold until ALT <3 × ULN × ULN ALT >5 × ULN Discontinue
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Available forms: Sol for SUBCUT inj 150 mg/1.14 mL, 200 mg/1.14 mL sin- gle-use prefilled syringes or prefilled pen
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Administer: SUBCUT route • A TB test before use; do not start ther- apy if patient has latent TB, treat first • Visually inspect for particulate mat- ter and discoloration before use; prod- uct is clear and colorless to pale yellow • Allow to sit at room temperature for 30 min, do not warm any other way • Inject full amount of the syringe • Do not rub the injection site • Dispose of used syringe or pen prop- erly. Do not recap after use. Do not reuse the pen or syringe • Rotate injection sites with each injection • Missed dose: Give as soon as possible if it has been ≤3 days; if longer discuss with health care provider • Storage: Use within 14 days after being taken out of the refrigerator
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Evaluate: • Therapeutic response: slowing pro- gression of rheumatoid arthritis
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CLINICAL CONSIDERATIONS Assess • Infection: flulike symptoms, fever, dys- pnea, inflammation of wounds; perform TB test before starting treatment • Reactivation of viral herpes zoster: blis- ters, rash, hepatitis B, dark urine, jaundice, clay-colored stools, weakness, fatigue, an- orexia, nausea, vomiting, abdominal pain; immediately report symptoms • GI reactions: assess for ulceration, ab- scess, perforation; monitor bowel habits, bowel sounds • Blood studies: AST, ALT at baseline, 4 wk and 8 wk after starting therapy, and q3mo thereafter; lipid levels: at base- line, 4 wk and 8 wk after starting treat- ment, and q6mo thereafter; platelets at baseline, 4 wk and 8 wk after starting therapy, and q3mo thereafter; neutro- phils: at baseline, 4 wk and 8 wk after starting therapy, and q3mo thereafter
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Patient and caregiver information: • The reason for therapy and expected re- sult • The correct technique for subcut in- jection and proper disposal of syringes; to review the Medication Guide • Infection: to report immediately fever, flulike symptoms, cough, blood in eme- sis, urine, stools; hypersensitivity: rash, itching • To avoid live virus vaccines while taking this product; that vaccinations should be brought up-to-date before treatment • To avoid OTC, herbal products or supplements without consent of pre- scriber; to discuss with all prescribers all medications and products taken • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or suspected or if breastfeeding; that preg- nant women should enroll in the preg- nancy registry at 877-311-8972 HIGH ALERT
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PHARMACOKINETICS Peak 2-4 days, duration 28-43 days depending on dose, half-life 150-mg dose is 8 days, 200-mg dose 10 days
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• Adult: SUBCUT 200 mg q2wk Dosage modifications Lab Value Recommendation ANC 0.5-1 × Hold until ANC 1 109/L × 109/L ANC <0.5 × Discontinue 109/L Platelets Hold until >100 × 50-100 × 103/ 103/mcl mcl S Platelets < 50 Discontinue × 103/mcl ALT >1 to ≤3 Consider dose × ULN modification ALT >3 to ≤5 Hold until ALT <3 × ULN × ULN ALT >5 × ULN Discontinue
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